Back Brace Coverage Medical Non-Pharmacy Protocols
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This policy governs when MedStar Family Choice utilization management staff may authorize payment for back braces for members in Maryland. It applies to back brace requests submitted through in-network providers or in-network durable medical equipment vendors and establishes coverage criteria, limitations, and medical exception review.
Rigid or semi-rigid orthoses were added as a coverage criterion for back braces.
The maximum brace cost eligible for nurse utilization management staff authorization increased from $500 or less to $1200 or less.
The utilization management criteria were changed from an OR relationship to an AND relationship.
The policy scope was updated to specify Maryland.
Responsible-party and approval entries were changed from specific names to organizational titles.
The policy reference links were updated.
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